What should I explain to a patient about their molluscum contagiosum?

From the Guidelines

I would explain to a patient that molluscum contagiosum is a common, benign viral skin infection that typically resolves on its own within 6-12 months without treatment, and that treatment options are available to speed up the process if necessary. The infection causes small, flesh-colored or pink bumps on the skin, which are contagious and can spread through direct skin contact, shared items like towels, or scratching 1. To prevent spreading, patients should avoid touching or scratching the bumps, keep them covered with clothing or bandages when possible, avoid sharing personal items, and practice good hand hygiene.

Treatment Options

Treatment options include:

• Watchful waiting, as the infection typically resolves on its own
• Physical removal methods like cryotherapy (freezing) or curettage (scraping)
• Topical medications, although imiquimod was not shown to be of benefit compared with placebo in randomized controlled trials 1
• Cantharidin, which has shown promise in open-label and observational studies, but its effectiveness is still being researched 1

Prognosis and Prevention

I would reassure them that while the condition can be frustrating, it's not dangerous and will eventually clear up completely without scarring in most cases. The virus only affects the outer layer of skin and doesn't cause systemic illness, which is why the body can eventually clear it without intervention, though treatment can speed up this process. According to a more recent study, in adults, large and multiple molluscum lesions with relatively little conjunctival inflammation may indicate an immunocompromised state 1.

Follow-up and Referral

Follow-up is not usually necessary unless the conjunctivitis persists, and referral to a dermatologist may be necessary for examination of other suspicious lesions 1.

From the FDA Drug Label

Imiquimod cream was evaluated in two randomized, vehicle-controlled, double-blind trials involving 702 pediatric subjects with molluscum contagiosum (MC) (470 exposed to imiquimod; median age 5 years, range 2-12 years). These studies failed to demonstrate efficacy Similar to the studies conducted in adults, the most frequently reported adverse reaction from 2 studies in children with molluscum contagiosum was application site reaction Adverse events which occurred more frequently in Imiquimod-treated subjects compared with vehicle-treated subjects generally resembled those seen in studies in indications approved for adults and also included otitis media (5% imiquimod vs. 3% vehicle) and conjunctivitis (3% imiquimod vs. 2% vehicle). Erythema was the most frequently reported local skin reaction Severe local skin reactions reported by treated subjects in the pediatric studies included erythema (28%), edema (8%), scabbing/crusting (5%), flaking/scaling (5%), erosion (2%) and weeping/exudate (2%)

You should explain to the patient that:

• Molluscum contagiosum is a condition that has been studied in pediatric subjects using imiquimod cream.
• The studies failed to demonstrate efficacy of imiquimod cream in treating molluscum contagiosum.
• Application site reactions are common adverse events associated with imiquimod cream, including erythema, edema, scabbing/crusting, flaking/scaling, erosion, and weeping/exudate.
• Other adverse events that may occur include otitis media and conjunctivitis. 2

From the Research

Explanation of Molluscum Contagiosum to a Patient

When explaining molluscum contagiosum to a patient, several key points should be covered:

• Definition and Cause: Molluscum contagiosum is a viral disease of the skin characterized by discrete, multiple, flesh-colored papules, caused by the molluscum contagiosum virus (MCV) 3.
• Transmission: The virus is highly infectious and transmission usually occurs through direct skin-to-skin contact, which can happen during sexual contact in adults or through activities like swimming in children 3, 4.
• Symptoms: The typical clinical presentation includes asymptomatic, flesh-colored, dome-shaped papules with central umbilication, which can appear on various parts of the body depending on the patient's age and immune status 3, 5, 4.
• Treatment Options: There is no specific treatment, but various methods can be used, including physical methods (curettage, cryotherapy), topical agents (cantharidin, imiquimod), and systemic agents 3, 6, 4. The choice of treatment depends on factors like the patient's age, number and severity of lesions, and personal preference.
• Prognosis and Prevention: Molluscum contagiosum is generally a self-limited disease, but its course can be protracted, and there is a risk of superinfection, scarring, autoinoculation, and transmission to others 3, 5, 4. Effective prevention is challenging due to the high infectivity of the virus, and there is no available vaccine 3.

Considerations for Specific Patient Groups

• Children: Molluscum contagiosum is very common in children, and the decision to treat should consider the potential for spontaneous resolution, the risk of scarring, and the child's discomfort or distress 6, 5, 4.
• Immunocompromised Patients: These patients may experience more severe or widespread lesions, and treatment should be tailored to their specific needs and immune status 3, 4.
• Sexually Active Adults: In adults, the disease is often sexually transmitted, and treatment should address the genital lesions while also considering the prevention of further transmission 3, 4.